الفهرس 
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Abstract
This study was done to assess and compare the efficacy of atropine alone and when combined with oximes and glycopyrrolate in treatment of patients with acute organophosphate poisoning by comparing the number of days of hospital stay, mortality rate and ventilator requirements and to compare the safety by monitoring the side effects of the used drugs.
A total of 80 acutely intoxicated patients with organophosphorus insecticide were selected from the Poison Control Center of El-Minia University Hospital who were admitted to the hospital during the period from the1st of March 2017 to the 28th of February 2018. The chosen patients were adults of both sex. Patients of both sex were divided into 4 groups:
• group I: 20 patients received atropine only.
• group II: 20 patients received atropine and obidoxime.
• group III: 20 patients received atropine and glycopyrrolate.
• group IV: 20 patients received atropine, glycopyrrolate and oximes.
There was significant decrease in pseudocholineesterase (PChE) level less than normal values on the day of admission in all groups with insignificant difference between groups both on admission and on discharge.
There was insignificant difference in the levels of blood urea nitrogen and serum creatinine among intoxicated patients. There was significant reduction in serum potassium level less than normal values and significant increase in blood glucose level above normal values in the all examined groups. Although There was insignificant difference among patients in the levels of serum Na+, K+ and serum glucose level.
There was insignificant difference in the levels of AST and ALT in intoxicated patients among different groups but there was a significant increase in the levels of AST and ALT above normal values in all examined groups on admission.
Treatment Parameters:
Total dose of atropine needed for atropinism and patient stabilization was not significantly changed in group (I) when compared with group (II), P=0.275. While glycopyrrolate significantly reduced the total dosage of atropine in group (III) and (IV) as compared to group (I) with P=0.002 and P<0.001 respectively.
Outcome & Mortality:
Mortality was 3.75 % as 3 patients died in the 1st 3 examined groups, meanwhile no mortality was recorded in group (IV) which received atropine, glycopyrrolate and obidoxime plus routine management.
Concerning hospital stay in this study, the mean duration of stay in hospital was 5.5±3.1 days. In comparison between groups, there was insignificant difference in duration of hospital stay in group (I) when compared with group (II), P=0.495. While there was a significant reduction in group (III) and (IV) as compared to group (I) with P=0.035, P=0.022 respectively. This may be due to the combined treatment of atropine with glycopyrrolate reduced dose of atropine thus improving the quality of treatment and decreasing the total duration that the patients stayed in hospital.
Mechanical ventilation was required by 16 patients (20%) but statistically there was insignificant difference in the need for mechanical ventilation between the study groups. There were 2 patients developed intermediate syndrome in group (I), 4 patients in group (II), 2 patients in group (III) and no patients in group (IV). Respiratory tract infection was seen in 20 patients (25%), most of the them were from group (I & II).
Glycopyrrolate induced a highly significant reduction in incidence of atropine adverse effects considering confusion, hallucinations and tachyarrhythmia in group (III) and (IV) when compared to group (I) and (II). Fever was seen in 44 patients (55%), most of the them were from group (I) and (II).